Basic Information
| Provider Information | |||||||||
| NPI: | 1780648741 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OB GYN ANESTHESIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E HAMPDEN AVE | ||||||||
| Address2: | 202 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037891940 | ||||||||
| FaxNumber: | 3037892132 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E HAMPDEN AVE | ||||||||
| Address2: | 202 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037891940 | ||||||||
| FaxNumber: | 3037892132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTHY | ||||||||
| AuthorizedOfficialFirstName: | LIAM | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3037891940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 04001285 | 05 | CO | MEDICAID |